SSRC Library

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Importance Trauma is a leading cause of death and disability for patients of all ages, many of whom are also among the most likely to be uninsured. Passage of the Patient Protection and Affordable Care Act was intended to improve access to care through improvements in insurance. However, despite nationally reported changes in the payer mix of patients, the extent of the law’s impact on insurance coverage among trauma patients is unknown, as is its success in improving trauma outcomes and promoting increased access to rehabilitation.

Objective To use rigorous quasi-experimental regression techniques to assess the extent of changes in insurance coverage, outcomes, and discharge to rehabilitation among adult trauma patients before and after Medicaid expansion and implementation of the remainder of the Patient Protection and Affordable Care Act.

Importance Trauma is a leading cause of death and disability for patients of all ages, many of whom are also among the most likely to be uninsured. Passage of the Patient Protection and Affordable Care Act was intended to improve access to care through improvements in insurance. However, despite nationally reported changes in the payer mix of patients, the extent of the law’s impact on insurance coverage among trauma patients is unknown, as is its success in improving trauma outcomes and promoting increased access to rehabilitation.

Objective To use rigorous quasi-experimental regression techniques to assess the extent of changes in insurance coverage, outcomes, and discharge to rehabilitation among adult trauma patients before and after Medicaid expansion and implementation of the remainder of the Patient Protection and Affordable Care Act.

Main Outcomes and Measures Changes in insurance coverage, outcomes (mortality, morbidity, failure to rescue, and length of stay), and discharge to rehabilitation.

Results A total of 283 878 patients from Medicaid expansion states and 285 851 patients from nonexpansion states were included (mean age [SD], 41.9 [14.1] years; 206 698 [36.3%] women). Adults with injuries in expansion states experienced a 13.7 percentage point increase in discharge to rehabilitation (95% CI, 7.0-7.8; baseline: 14.7%) that persisted across inpatient rehabilitation facilities (4.5 percentage points), home health agencies (2.9 percentage points), and skilled nursing facilities (1.0 percentage points). There was also a 2.6 percentage point drop in failure to rescue and a 0.84-day increase in length of stay. Rehabilitation changes were most pronounced among patients eligible for rehabilitation coverage under the 2-midnight (8.4 percentage points) and 60% (10.2 percentage points) Medicaid payment rules. Medicaid expansion increased rehabilitation access for patients with the most severe injuries and conditions requiring postdischarge care (eg, pelvic fracture). It mitigated race/ethnicity-, age-, and sex-based disparities in which patients use rehabilitation.

Conclusions and relevance This multistate assessment demonstrated significant changes in insurance coverage and discharge to rehabilitation among adult trauma patients that were greater in Medicaid expansion than nonexpansion states. By targeting subgroups of the trauma population most likely to be uninsured, rehabilitation gains associated with Medicaid have the potential to improve survival and functional outcomes for more than 60 000 additional adult trauma patients nationally in expansion states. (Author abstract)

U.S. children are more likely to live apart from a biological parent than at any time in history. Although the Child Support Enforcement system has tremendous reach, its policies have not kept pace with significant economic, demographic, and cultural changes. Narrative analysis of in-depth interviews with 429 low-income noncustodial fathers suggests that the system faces a crisis of legitimacy. Visualization of language used to describe all forms child support show that the formal system is considered punitive and to lead to a loss of power and autonomy. Further, it is not associated with coparenting or the father–child bond—themes closely associated with informal and in-kind support. Rather than stoking men’s identities as providers, the system becomes “just another bill to pay.” Orders must be sustainable, all fathers should have coparenting agreements, and alternative forms of support should count toward fathers’ obligations. Recovery of government welfare costs should be eliminated. (Author abstract)

U.S. children are more likely to live apart from a biological parent than at any time in history. Although the Child Support Enforcement system has tremendous reach, its policies have not kept pace with significant economic, demographic, and cultural changes. Narrative analysis of in-depth interviews with 429 low-income noncustodial fathers suggests that the system faces a crisis of legitimacy. Visualization of language used to describe all forms child support show that the formal system is considered punitive and to lead to a loss of power and autonomy. Further, it is not associated with coparenting or the father–child bond—themes closely associated with informal and in-kind support. Rather than stoking men’s identities as providers, the system becomes “just another bill to pay.” Orders must be sustainable, all fathers should have coparenting agreements, and alternative forms of support should count toward fathers’ obligations. Recovery of government welfare costs should be eliminated. (Author abstract)

The Self-Sufficiency Research Clearinghouse (SSRC) sponsored a webinar, Beyond Housing Policy: Human Service Policies to Address Housing Instability, on March 7, 2018, 2:00-3:30pm EST. The webinar focused on human service policies and programs that may directly influence low-income and vulnerable families’ housing stability. There is a well-established connection between consistent, stable, and affordable housing and positive family physical, emotional, and economic well-being. Housing instability – frequent moves because of social, familial, financial, mental health, and violence related issues – is common among low-income households and other vulnerable populations such as recently incarcerated individuals. A lack of stable housing is linked to increased food insecurity, mental health barriers, physical hardships, and poorer education outcomes for children. These negative outcomes become more prevalent and extreme when housing instability leads to homelessness. While there is little argument over housing stability and its connection to family self-sufficiency, there is...

The Self-Sufficiency Research Clearinghouse (SSRC) sponsored a webinar, Beyond Housing Policy: Human Service Policies to Address Housing Instability, on March 7, 2018, 2:00-3:30pm EST. The webinar focused on human service policies and programs that may directly influence low-income and vulnerable families’ housing stability. There is a well-established connection between consistent, stable, and affordable housing and positive family physical, emotional, and economic well-being. Housing instability – frequent moves because of social, familial, financial, mental health, and violence related issues – is common among low-income households and other vulnerable populations such as recently incarcerated individuals. A lack of stable housing is linked to increased food insecurity, mental health barriers, physical hardships, and poorer education outcomes for children. These negative outcomes become more prevalent and extreme when housing instability leads to homelessness. While there is little argument over housing stability and its connection to family self-sufficiency, there is less clarity on how to efficiently and effectively address this housing challenge. The supply of affordable housing has declined while overall levels of housing instability have increased. There is evidence showing how housing subsidies for low-income individuals increase housing stability, but less than 25 percent of the 19 million eligible households receive this support. In addition, waiting lists for housing subsidies and other forms of assistance can be up to three years long. Given these challenges, it is important to understand the potential of other human services supports and policies, besides housing assistance, to promote positive housing outcomes for low-income individuals.

This document is the transcript from Beyond Housing Policy: Human Service Policies to Address Housing Instability. Listen to the recording from the Webinar here. The webinar PowerPoint slides can be found here. A record of the question and answer session from the webinar can be found here.

The Self-Sufficiency Research Clearinghouse (SSRC) sponsored a webinar, Beyond Housing Policy: Human Service Policies to Address Housing Instability, on March 7, 2018, 2:00-3:30pm EST. The webinar focused on human service policies and programs that may directly influence low-income and vulnerable families’ housing stability. There is a well-established connection between consistent, stable, and affordable housing and positive family physical, emotional, and economic well-being. Housing instability – frequent moves because of social, familial, financial, mental health, and violence related issues – is common among low-income households and other vulnerable populations such as recently incarcerated individuals. A lack of stable housing is linked to increased food insecurity, mental health barriers, physical hardships, and poorer education outcomes for children. These negative outcomes become more prevalent and extreme when housing instability leads to homelessness. While there is little argument over housing stability and its connection to family self-sufficiency, there is less...

The Self-Sufficiency Research Clearinghouse (SSRC) sponsored a webinar, Beyond Housing Policy: Human Service Policies to Address Housing Instability, on March 7, 2018, 2:00-3:30pm EST. The webinar focused on human service policies and programs that may directly influence low-income and vulnerable families’ housing stability. There is a well-established connection between consistent, stable, and affordable housing and positive family physical, emotional, and economic well-being. Housing instability – frequent moves because of social, familial, financial, mental health, and violence related issues – is common among low-income households and other vulnerable populations such as recently incarcerated individuals. A lack of stable housing is linked to increased food insecurity, mental health barriers, physical hardships, and poorer education outcomes for children. These negative outcomes become more prevalent and extreme when housing instability leads to homelessness. While there is little argument over housing stability and its connection to family self-sufficiency, there is less clarity on how to efficiently and effectively address this housing challenge. The supply of affordable housing has declined while overall levels of housing instability have increased. There is evidence showing how housing subsidies for low-income individuals increase housing stability, but less than 25 percent of the 19 million eligible households receive this support. In addition, waiting lists for housing subsidies and other forms of assistance can be up to three years long. Given these challenges, it is important to understand the potential of other human services supports and policies, besides housing assistance, to promote positive housing outcomes for low-income individuals.

This document is the Q&A from Beyond Housing Policy: Human Service Policies to Address Housing Instability. Listen to the recording from the Webinar here. The webinar transcript can be found here. The PowerPoint presentation from the webinar can be found here.

The Self-Sufficiency Research Clearinghouse (SSRC) sponsored a webinar, Beyond Housing Policy: Human Service Policies to Address Housing Instability, on March 7, 2018, 2:00-3:30pm EST. The webinar focused on human service policies and programs that may directly influence low-income and vulnerable families’ housing stability. There is a well-established connection between consistent, stable, and affordable housing and positive family physical, emotional, and economic well-being. Housing instability – frequent moves because of social, familial, financial, mental health, and violence related issues – is common among low-income households and other vulnerable populations such as recently incarcerated individuals. A lack of stable housing is linked to increased food insecurity, mental health barriers, physical hardships, and poorer education outcomes for children. These negative outcomes become more prevalent and extreme when housing instability leads to homelessness. While there is little argument over housing stability and its connection to family self-sufficiency, there is less...

The Self-Sufficiency Research Clearinghouse (SSRC) sponsored a webinar, Beyond Housing Policy: Human Service Policies to Address Housing Instability, on March 7, 2018, 2:00-3:30pm EST. The webinar focused on human service policies and programs that may directly influence low-income and vulnerable families’ housing stability. There is a well-established connection between consistent, stable, and affordable housing and positive family physical, emotional, and economic well-being. Housing instability – frequent moves because of social, familial, financial, mental health, and violence related issues – is common among low-income households and other vulnerable populations such as recently incarcerated individuals. A lack of stable housing is linked to increased food insecurity, mental health barriers, physical hardships, and poorer education outcomes for children. These negative outcomes become more prevalent and extreme when housing instability leads to homelessness. While there is little argument over housing stability and its connection to family self-sufficiency, there is less clarity on how to efficiently and effectively address this housing challenge. The supply of affordable housing has declined while overall levels of housing instability have increased. There is evidence showing how housing subsidies for low-income individuals increase housing stability, but less than 25 percent of the 19 million eligible households receive this support. In addition, waiting lists for housing subsidies and other forms of assistance can be up to three years long. Given these challenges, it is important to understand the potential of other human services supports and policies, besides housing assistance, to promote positive housing outcomes for low-income individuals.

This is the PowerPoint presentation from the webinar. Listen to the recording from the Webinar here. The webinar transcript can be found here. A record of the question and answer session from the webinar can be found here.